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Factors Influencing the Job Satisfaction of Health System
Employees in Tabriz, Iran
Shokoufe Bagheri 1, *Ahmad Kousha 2, Ali Janati 3, Mohammad Asghari-Jafarabadi 4
1
Student Research Committee, School of Health & Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Health Education and Promotion, School of Health & Nutrition,
Tabriz University of Medical Sciences, Tabriz, Iran
3 Tabriz Health Services Management Research Center, Department of Health Care Management, School of Health
& Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
4Tabriz Health Services Management Research Center, Department of Statistics and Epidemiology, School of Health and
Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
(Received: 13 Mar 2012/ Accepted: 01 Aug 2012)
ABSTRACT
Background: Employees can be counseled on how they feel about their job. If any particular dimension of their job is causing them dissatisfaction, they can be assisted to appropriately change it. In this study, we investigated the factors affecting job satisfaction from the perspective of employees working in the health system and thereby a quantitative measure of job satisfaction. Methods: Using eight focus group discussions (n=70), factors affecting job satisfaction of the employees were discussed. The factors identified from literature review were categorized in four groups: structural and managerial, social, work in it-self, environmental and welfare factors. Results: The findings confirmed the significance of structural and managerial, social, work in it-self, environmental and welfare factors in the level of job satisfaction. In addition, a new factor related to individual characteristics such as employee personal characteristics and development was identified.
Conclusion: In order to improve the quality and productivity of work, besides, structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should be taken into account individual characteristics of the employee as a factor affecting job satisfaction. Keywords: Job satisfaction, Health system employee, Qualitative study
Introduction
Job satisfaction is defined as harmo-nizing the people's understanding of needs and what they receive from their jobs and is recognized as one of the most important re-search variables belonging to organizational behaviors and also as a crucial variable in the organization's researches and theories [1].
Improving the quality of health ser-vices is a continuing challenge to managers
in the health system [2].As a matter of fact, the job satisfaction of health care employees is a very important factor that has a pro-found impact on productivity as well as on the quality of patient care [3]. Job satisfac-tion has a direct link with absenteeism and turnover of the staff in organizations [4]. Nearly 70% of the physicians working in the teaching hospital of Karachi were not
ORIGINAL ARTICLE Open Access
Citation: Bagheri SH, Kousha A, Janati, Asghari-Jafarabadi M. Factors Influencing the Job Satisfaction of Health System Employees in Tabriz, Iran. Health Promot Perspect 2012; 2 (2): 190-196.
191 fied with their job, which, in turn, affected
the quality of their work [5]. The issue of job satisfaction has always been considered as a problem in organizations and still is. In a way that up to the year 1980, more than 4000 articles have been published concern-ing this [6].
The factors that impact job satisfac-tion are often categorized into extrinsic and intrinsic ones [7]. Intrinsic factors are related to the work itself (such as the ability to de-velop one’s skills, sense of autonomy, suc-cess, achievement and control); whereas ex-trinsic factors are not directly related to work itself (such as, salary, relationships with colleagues) [7-8].
As well as autonomy and cohesion with colleagues, many factors such as task variety, feedback, promotional opportuni-ties, task identity (professional status), working conditions, collaboration with the staff and strength of the organizational cul-ture have been associated with job satisfac-tion [9]. Demographic variables, job charac-teristics and organizational environment factors contribute to job satisfaction [8]. Most Singapore's doctors are rather satisfied with their freedom of action to treat patients (92%) and the kind of their relationships with patients (94%); furthermore their most dissatisfaction is related to their leisure time (48%) and their work improvement and promotion (38%) [10].
The lack of valid evidence in the di-verse areas of defining and measuring job satisfaction and its relation with other con-cepts such as functionality and job effi-ciency, absence and the like, indicates that most of researches and studies used to termine job satisfaction have failed to de-termine its dimensions, aspects and factors accurately and completely [11].
In this study, we investigated health system employees’ perspectives on work factors most affecting job satisfaction.
Methods
Focus Group Discussion (FGD) were used as an appropriate qualitative method to
elicit knowledge, beliefs, feelings, and expe-riences of health system employees about the factors affecting job satisfaction, and to gauge the congruence of their attitudes with these aspects found in the literature in order to identify potential aspects of job satisfaction.
Seventy health system employees were selected from four departments: East Azer-baijan provincial health center, treatment cen-ter, teaching hospital center and health care center. The selected employees participated in 8 FGDs from March, 2011 to June, 2011.
The study participants were selected using a purposive sampling method and the inclusion criteria were having at least 5 years of work experience, as general practitioner, midwife, nurse, occupational health worker, or environmental health worker. We reached the saturation when after 8 sessions of FGDs, all themes and issues were repetitive and there were no new issues to discuss about. Approximately 90% of those invited to participate in the study attended the FGDs. Refusals were for personal reasons such as work time interference with FGD session hours and fear of losing their job.
A semi-structured questionnaire was designed using material obtained from the literature review, and structural and mana-gerial, social; work it-self, environmental and welfare issues were discussed with FGD members. Each session lasted to 60-90 min and started with a broad opening question. The opening question focused on identifying the most important issues related to group members’ job satisfaction. All FGDs were recorded using a voice recorder and verba-tim transcriptions were prepared. To assess respondent validity, before analysis, all re-corders were checked with the notes and all notes were checked for correctness with participants. To ensure expert validation, the interview contents were checked and evaluated by two specialists and their as-sessments were combined.
Thematic analyses, as used by Ma-nongi et al. (2006) [12] were used on the transcripts through 3 stages.
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Primary coding was developed from aspects emerging from the familiarization stage.
Stage 2: The process of applying codes to the data. Textual codes were used to rec-ognize specific pieces of data and differing themes.
Stage 3: Development of themes emerging from the discourse.
All FGD participants were informed that all findings would be kept strictly confi-dential and that they could quit participating in the study at any time.
Results
Approximately half of participants (51.4%) were 40-49 yr of age. 55.7% were male. For most participants employment status was formal with 81.4% of the partici-pants being of permanent employment sta-tus. Those who stayed in their job were 10-19 yr of age (64.3%) (Table 1).
Table 1: Characteristics of health system employees participating in the focus group
discussions
Characteristics Participants (n= 70)
n % Age (yr)
30-39 30 42.9
40-49 36 51.4
50 and more 4 5.7
Gender
Male 39 55.7
Female 31 44.3
Employment status
Formal 57 81.4
Informal 13 18.6
Tenure (years)
5-9 10 14.3
10-14 27 38.6
15-19 18 25.7
20 and more 15 21.4
Findings of FGDs showed that in ad-dition to structural, managerial, social, work in it-self, environmental and welfare factors, a new theme was identified from FGDs: individual characteristics (Table 2).
Table 2: Health system staffs' perspective on Factors affecting job satisfaction
Theme Sub theme
Structural and managerial factors
-Lack of discrimination in the organization
-Executive power of managers - Performance-based manage-ment systems in organizations - Existence of the participatory management system
- Transparent selection and appointment of managers - Clear promotion path for staffs in organization
- Intersectional collaboration - Appropriate reward and pu-nishment systems in
organiza-tion
- Job security - Delegation
- Evaluation system in organization
- Specific duties
- Support of employees needs by managers
- Congruence of manager edu-cation level with his organiza-tional position
Social factors - Organizational relationships, -Informed policy makers about the value the health system - Customer satisfaction
Individual factors
-Personal characteristics - Personal development
Work it-self factors
-the right person being on the right job
-Job prestige - Workload - Interesting job
Environmental and welfare factors
- Salary and organizational benefits
- Suitability of work equipment, -Work environment and physi-cal conditions, ,
- Relation between workload and payment
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Structural and managerial factors
Based on participants' perspectives, lack of discrimination in the organization, executive power of managers, performance-based management systems in organizations, existence of a participatory management system, transparent selection and appoint-ment of managers, clear promotion path for staff in organization, intersectional collabo-ration, appropriate reward and punishment systems in the organization, job security, delegation, evaluation system in organiza-tion, specific duties, support of employees needs by managers, correlation of managers’ education level with their organizational positions were the most important factors affecting job satisfaction.
Some of the issues raised during the discussion were as follows:
“There is something which causes sa-tisfaction and dissasa-tisfaction… that is dis-crimination… we are doctors … what is the difference between me who works in the primary health system and my friend who works in the treatment system?” (P3, FG4). “When I was an operator, my position was higher than it is now. Now I am an envi-ronmental expert … a bank accountant who has 1 or 2 years’ work experience gets pro-moted over time” (P 9, FG1). “We have no job responsibility description”(P5, FG2).
“Another issue is delegation which is now almost zero degree” (P5, FG2).
Social factors
FGDs participants believe that organi-zational relationships, informed policy mak-ers about the value the health system and customer satisfaction are social factors which need to be considered by all actors of the health system.
Some of participants’ discussions are: “A personal relationship with others or even with the direct manager or top man-agers, relations with colleagues (how friendly they are), relations with other sub-units… “Relation can be classified in another cate-gory” (P5, FG2). “When we want to talk to our managers, they say what are you doing in health units?” (P 4, FG4).
Individual characteristics
The study participants expressed that individual factors such as personal characte-ristics and development were directly related to job satisfaction.
For example participants believed that: “Personal characteristics such as personality and temperament are important in job satis-faction”(P 3, FG1). “Personal development is very important... and this directly impacts job satisfaction” (P6).
Factors intrinsic to the job
Participants believed that factors re-lated to the job in it-self were a determining element in job satisfaction and included the right person being on the right job, job prestige, workload and interest in the job.
Some of our subject's views are: “Lack of compatibility between job and academic degree …. I think this is one of the factors causing dissatisfaction” (P2, FG2). “Work overload is also another issue which contributes to dissatisfaction”(P2, FG7).
Environmental and welfare factors
From participants’ perspective, salary and organizational benefits were environ-mental factors affecting job satisfaction. Suitability of work equipment, work envi-ronment and physical conditions, relation between workload and payment, transporta-tion, provision of travel opportunity using organizational resources, loans (housing, marriage and etc), are important.
Furthermore, FGD members ex-pressed: “The main concern of general practitioners is low income”(P5, FG4). “Work equipment is another influential factor in job satisfaction and dissatisfaction” (P3, FG2). “Another factor could be physical conditions of the workplace, such as light, air conditions and welfare facilities”(P1, FG3). “Lack of transportation services also leads to dissatisfaction”(P5, FG5).
Discussion
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factors were indicated as affecting job satis-faction. Findings are in agreement with those reported in articles published in Iran. Mo-vahhed and Moghadam [13] classified factors affecting job satisfaction among nurses into the following categories: work security, rela-tions, managerial and social conditions.
Furthermore, regarding structural and managerial factors, the results of our study showed that discrimination was one of the major issues. This is in agreement with the findings of Bester and colleagues [14]. Justice plays a pivotal role in the organization and job satisfaction and the way individuals are treated directly affects their axioms, emo-tions, attitudes and their manners and the-reby, their satisfaction [15]. Therefore, it can be argued that the way employees are judged, the existence of justice in organizations, and employees’ reactions to such equality or in-equality influence the degree of job satisfac-tion felt. A manager's full support of staff is mentioned as one of the structural and mana-gerial factors. This finding is consistent with the finding of El-Salam stated that nurses are supported by managers; tend to be successful at their jobs [16]. The more the managers' support, the less is the occurrence of medical and nursing errors [17]. Participants also mentioned that the existence of a participa-tory management style is an influential factor in job satisfaction. A participatory manage-ment style could result in increasing job satis-faction levels, sense of trust and power [16, 18-19]. Therefore, in the work field, if super-visors and staff do consult with each other and colleagues cooperate with each other in decision making, then all these factors will tend to increase job satisfaction levels. Lack of appropriate reward and punishment sys-tems in an organization, which decreases the desire in people to perform better and makes them disappointed or even alienates them from the organization, was found in Stone and colleagues study [20] and this finding is in line with ours.
The findings of Asl et al., [21], as well as findings of our study indicate that transcendental values which provoke satis-faction in employees consist of recognition of
their merits, respect for them, freedom in their performance and work security.
Furthermore, as regards factors per-taining to the individual, our findings indicate that personal characteristics and possibility for individual development of the employee affect job satisfaction. The same factors af-fecting job satisfaction were revealed in another study [22] and included genetic fac-tors and personal characteristics.
Concerning the social dimension, an appropriate organizational the relationship with colleagues and managers is mentioned as an important factor throughout the FGDs. Having a good relationship with the manager tends to decrease stress in staff. On the other hand, a weak relationship and lack of good supervision increased job related stress, sense of loneliness and distrust to the manager [19]. Furthermore, good relations with colleagues are important in feeling respected and sup-ported and increases the level of motivation in employees. A good support of colleagues and a good relationship with them has multi-dimensional effects on the work environ-ment, motivation of staff and creates a posi-tive attitude in employees. A supporposi-tive envi-ronment increases the individual’s efforts to reach the organizational goals. Having good relations with managers creates an atmos-phere in which the sense of being healthy and cheerful, the sense of having enough welfare and the level of satisfaction will improve [23]. On the dimension of work in it-self, an appropriate workload is mentioned as an im-portant factor throughout the FGDs. A study [19], reveals that work overload is one of the most influential factors upon nurses’ negative attitudes toward their organizational atmos-phere. High workload tends to increase the sense of tiredness and, aggravated by inade-quate sleep, leads to negative organizational and individual performance [24]. Work overload will lead to work depression, tired-ness and lack of power [16].
atti-195 tudes towards the organization and their job
satisfaction [17].
Limitations of the study
This study only explored the subjective views of employees in the health system and the responses obtained were analyzed only theoretically. Therefore, the factors unco-vered are by no means exhaustive. Another limitation of this study is that only the views and experiences of some health personnel who were able to participate in the study were collected; therefore, the factors discovered to affect job satisfaction are by no means ex-haustive. Further research is needed to con-firm the findings of this investigation.
Conclusion
In order to improve the quality and productivity of work, apart from structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should take into account the individ-ual characteristics of the employees as a fac-tor affecting job satisfaction. We did not find any qualitative research has been conducted in this field in Iran, the present study is the first to identify factors affecting job satisfac-tion in the target populasatisfac-tion, and the ob-tained findings provide guidelines for con-structing a questionnaire of job satisfaction conforming to conditions prevailing in the Iranian health system.
Acknowledgments
The authors thank Vice-Chancellor of Research of the Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran for the financial support provided. All partici-pants in this study are also appreciated for their contribution. The authors declare that there is no conflict of interest.
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